Surgeon a 'scapegoat' for bad facilities

A CONSULTANT surgeon whose 39-year-old patient died after three operations for appendicitis was being made “a scapegoat” because of lack of facilities at a Co Clare hospital, an expert witness for the doctor told a Medical Council fitness-to-practise inquiry yesterday.

Ian Finlay, consultant surgeon at Glasgow Royal Infirmary, Scotland, said there was “no doubt” post-operative facilities at the Mid-Western Regional Hospital in Ennis, where Dr Syed Naqvi performed the procedures, were not what would be expected in 2008 when the surgery took place.

“It was not an intensive-care unit; it is debatable whether it was a high-dependency unit,” he said. “Dr Naqvi wasn’t responsible for the facilities; he was making the best decisions he could.”

Martina Sherlock from Ennis, Co Clare, died from organ failure caused by sepsis in December 2008. The mother of 13 first attended the emergency department at Ennis hospital in June 2008 with abdominal pain, but was not diagnosed with appendicitis until November that year. She died less than a month later after undergoing three operations in three weeks.

The first procedure involved the removal of an appendix mass and part of Ms Sherlock’s colon. This led to complications including infection and leakage from the colon, and two more operations were undertaken.

Dr Naqvi is facing 11 allegations of professional misconduct and/or poor professional performance in connection with her care. These include that he carried out an inappropriate operation, failed to arrange for CT scans when required, and failed to transfer Ms Sherlock to the Midwestern Regional Hospital Limerick within an adequate time period.

Mr Finlay told the inquiry the doctor was put in an “unenviable place” in advance of the third operation on Ms Sherlock. He could have sent the patient to the Limerick hospital where better intensive-care facilities were available and there was access to a CT scanner. But her condition was deteriorating and he decided to do the third operation at Ennis, removing another section of bowel. “I have no doubt if Mr Naqvi could rewind the clock, he would have referred to Limerick,” he said. But the culture at the Ennis hospital was one that was used to dealing with complicated cases with limited facilities. “It is very unfortunate that because we’ve got a lack of facilities, to make the surgeon a scapegoat for his best intention,” Mr Finlay said.

He also defended the nature of the third procedure carried out by Dr Naqvi, describing it as an “appropriate resection”. And he referred to some of the complaints against the surgeon as “nit-picking” and “unfair”. Under cross-examination, he said Ms Sherlock was well enough to be transferred.

Earlier yesterday, expert witness for the Medical Council Anthony Peel, a consultant surgeon at St Bartholomew’s Hospital in London, said he could “not conceive of a surgeon” carrying out the third procedure. It was “a dangerous procedure” in the circumstances and would reduce her chances of survival, he said.

Mr Peel said he believed Ms Sherlock should have been transferred to Limerick before the surgery. And a decision not to transfer her directly after the third surgery “was inherently dangerous as it allowed the situation to develop” to a more serious state.